1. Field of the Invention
This invention relates to a brace and method for immobilizing a fracture which allows the physician to adjustably position the pressure applied by the brace to more effectively reduce and immobilize the fracture. More particularly, the preferred brace of the present invention is designed to treat fractures in the hand, while allowing movement of the fingers and the wrist.
2. Description of the Prior Art
Approximately one-half of all accidents involve fractures in the hand or fingers. Fractures in the bones of the hand comprise approximately one-third of all fractures. The most frequent hand fracture involves the metacarpal, particularly the fifth metacarpal or a so called "boxer's fracture". Typical metacarpal deformity involves apex dorsal angulation. Since the metacarpal is somewhat superficial, the deformity takes the form of a bump on the dorsam of the hand and loss of the metacarpal head definition. The resulting prominence of the metacarpal head in the palm can cause discomfort, particularly in an individual who must grip tools or do heavy manual labor in his chosen profession.
Previous studies of hand fractures have suggested that angulation of the fracture up to 40.degree. was acceptable without even attempting reduction of the fracture. Further, these studies suggest that if reduction could not easily be performed under a local anesthesia, angulation up to 70.degree. was acceptable provided there was not excessive rotation of a distal fragment. Additionally, these studies suggested that angulation up to 70.degree. was acceptable if the reduction could not be readily maintained.
More recent studies and text books reference patient dissatisfaction cosmetically, symptomatically and functionally with this degree of deformity. Today the maximum acceptable angular deformity is around 30.degree. in the fifth metacarpal, to only 10.degree.-15.degree. in the second and third metacarpal bones.
There are many types of treatment, reduction, and immobilization for metacarpal fractures. These include the use of casts, splints and mechanical devices to achieve the reduction and immobilization. The most common treatment of metacarpal fractures involves the use of an ulnar gutter plaster splint which immobilizes the wrist and certain fingers, depending upon the location of the metacarpal fracture.
There are a number of deficiencies in the use of such casts and splints in the treatment of fractures, particularly metacarpal fractures of the hand. Conventional casts and splints immobilize the fingers, wrists, and to some extent the forearm, which effectively prevents most use of the hand by the patient. Further, conventional casts and splints not only shield the area of the fracture from visual inspection, but additionally substantially degrades the quality of radiographs for monitoring the healing of the fracture.
Further, such conventional casts and splints are not always effective in applying the appropriate amount of pressure at the appropriate locations for a given fracture, particularly a metacarpal fracture. That is, even assuming that proper reduction can initially be made within acceptable angulation limits, there is risk of shifting and rotation of the fracture outside of acceptable angulation limits, in part due to inappropriate pressure. When coupled with the difficulties in visual and radiographic inspection of the fracture reduction, it is readily apparent that conventional casts and splints are lacking in many respects in the treatment of fractures, particularly metacarpal fractures. Therefore, it would be a significant advance in the art if a method and device were devised that the physician could readily adapt to provide the appropriate pressure to a fracture to achieve the desired reduction and immobilization. Further, a device which was inexpensive, permitted visual inspection, and was radiolucent, would be highly desirable in the treatment of fractures, particularly, hand fractures such as metacarpal fractures.